title: Assessment of functional ability in patients with scleroderma: a proposed new disability assessment instrument.
abstract: OBJECTIVE
  To develop a simple assessment of functional ability in patients with scleroderma and to examine its reliability both as a patient self-administered instrument and when administered by a trained observer.
  
  
  METHODS
  An 11 item, 4 grade, functional assessment questionnaire was developed after extensive consultation with patients, physiotherapists (PT), and occupational therapists (OT) with the aim of including all functional areas of relevance. The instrument was self-administered by patients after an interval of 7 days. In the interval, the patients were assessed using the same instrument by direct observation from both a PT and an OT. Forty-seven patients with scleroderma, of varying severity, were recruited from 2 centers. Results were similar for both centers and data were pooled for analysis.
  
  
  RESULTS
  Agreement between the patients' first and 2nd assessment was good for all questions (estimated kappas 0.69 to 0.94) with no evidence of an order effect. Agreement was also good between therapists (estimated kappas 0.47 to 0.81). There was poor agreement between patients and therapists, with patients rating their disability substantially higher compared to the standardized therapist assessment.
  
  
  CONCLUSIONS
  This assessment schedule has high face and content validity and has excellent reliability both between trained therapists and within patients over a short time period. Its administration either as a self-report or by a therapist depends, in part, on the type of investigation undertaken.
authors.affiliation: ARC Epidemiology Research Unit, University of Manchester Medical School, UK.
authors.forename: A
authors.initials: A
authors.lastname: Silman
authors.forename: A
authors.initials: A
authors.lastname: Akesson
authors.forename: J
authors.initials: J
authors.lastname: Newman
authors.forename: H
authors.initials: H
authors.lastname: Henriksson
authors.forename: G
authors.initials: G
authors.lastname: Sandquist
authors.forename: M
authors.initials: M
authors.lastname: Nihill
authors.forename: S
authors.initials: S
authors.lastname: Palfrey
authors.forename: R
authors.initials: R
authors.lastname: Lomas
authors.forename: F
authors.initials: F
authors.lastname: Wollheim
authors.forename: C
authors.initials: C
authors.lastname: Black
mesh_terms: D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012595:Scleroderma, Systemic / Q000523:psychology*; D011795:Surveys and Questionnaires